Steering mechanism

ABSTRACT

A steering mechanism is used as part of a medical device such as a catheter or an endoscope to allow movement of a steerable distal portion of the catheter or endoscope. The mechanism can include a elongate housing adapted to be coupled to the steerable portion of the medical device and an actuation system including an actuator, a first cam, and a second cam. The actuator can move the first cam between a first position and a second position along a first axis (or about a second axis different than the first axis) to move the steerable portion of the medical device along a first plane. The actuator can move the second cam between a first position and a second position along the second axis (or about the first axis) to move the steerable portion of the medical device along a second plane different than the first plane.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to and the benefit of Provisional U.S.Patent Application Ser. No. 61/113,621, filed Nov. 12, 2008, theentirety of which is incorporated herein by reference.

TECHNICAL FIELD

The invention generally relates to a mechanism for controllingarticulation of a steerable portion of a medical device, and moreparticularly to a steering mechanism that utilizes a mechanicaladvantage to control articulation of the steerable portion on at leasttwo planes.

BACKGROUND INFORMATION

Steering mechanisms are used to steer or direct a medical instrument,for example a catheter or endoscope, to a desired position or locationin a body of a patient. One known steering mechanism resembles ajoystick. The configuration of the joystick usually includes a plateattached to control wires. The plate, however, must be large toaccommodate the desired articulations of the steerable medical device.Additionally, the single control element encompassed in the joystickcontrol mechanism makes the introduction of force leverage difficult,especially in a procedure during which an increased leverage is neededfor different articulation planes.

Another known steering mechanism includes multiple slidable buttons.Each button is connected to a puller wire so that when the button ismoved, the puller wire moves the catheter in a single directionassociated with the puller wire. Thus, at least four slidable buttonsare required to achieve 360 degree articulation of the catheter orendoscope. The sliding motion of the buttons on this steering mechanismmakes introduction of force leverage very difficult.

SUMMARY OF THE INVENTION

It is an object of the invention to allow steering operation of asteerable portion of a medical device along multiple planes. A steeringmechanism according to the invention can control articulation of asteerable portion of a medical device along at least two differentplanes. A steering mechanism according to the invention can alsointroduce a mechanical advantage, e.g. force leverage, during operationof the steering mechanism to move the steerable portion of the medicaldevice along each plane.

In one aspect, the invention relates to a steering mechanism for use aspart of a medical device. The steering mechanism can comprise anelongate housing and an actuation system. The housing is adapted to becoupled to a steerable member of a medical device. The actuation systemis coupled to the elongate housing. The actuation system is adapted tocontrol movement of the steerable member of the medical device within abody of a patient. The actuation system includes an actuator, a firstcam, and a second cam. The actuator is adapted to move the first camfrom a first position to a second position different than the firstposition when the actuator is moved in a first direction about a firstaxis. The first cam is adapted to move the steerable member of themedical device in a first direction along a first plane when the firstcam is moved from the first position to the second position. Theactuator is adapted to move the second cam from a first position to asecond position different than the first position when the actuator ismoved in a first direction about a second axis different than the firstaxis. The second cam is adapted to move the steerable member of themedical device in a first direction along a second plane when the secondcam is moved from the first position to the second position.

Embodiments according to this aspect of the invention can includevarious features. For example, the steering mechanism can include aprotrusion coupled to the first cam. The protrusion is adapted to movein a first direction when the actuator is moved in its first directionalong the second axis and is adapted to engage a portion of the secondcam as the protrusion is moved in its first direction. The protrusioncan be adapted to move the second cam from its first position to itssecond position as the protrusion is moved in the first direction.

In another example, the elongate housing of the steering mechanism caninclude a first grip portion and a second grip portion different thanthe first grip portion. The actuator can be coupled to the elongatehousing between the first grip portion and the second grip portion. Theelongate housing is adapted to be in a first orientation whenoperatively held by the first grip portion. The first orientation of theelongate housing can be a substantially horizontal orientation. Theelongate housing is adapted to be in a second orientation different thanthe first orientation when operatively held by the second grip portion.The second orientation of the elongate housing can be a substantiallyvertical orientation.

In some embodiments, at least a portion of the elongate housingincluding a distal end portion of the elongate housing substantiallyextends along the first axis. In some embodiments, at least a portion ofthe elongate housing including a proximal end portion of the elongatehousing substantially extends along an axis different than the firstaxis.

In another example, the first cam and the second cam are adapted torotate about the second axis. In some embodiments, the actuator isadapted to move the first cam from its second position to at least oneof the first position or a third position different than the firstposition when the actuator is moved in a second direction different thanthe first direction about the first axis. The first cam can be adaptedto move the steerable member in a second direction different than thefirst direction along the first plane when the first cam is moved fromthe second position to the at least one of the first position or thethird position. The actuator can be adapted to move the second cam fromthe second position to at least one of the first position and a thirdposition different than the third position when the actuator is moved ina second direction different than the first direction about the secondaxis. The second cam can be adapted to move the steerable member in asecond direction different than the first direction along the secondplane when the second cam is moved from the second position to the atleast one of the first position or the third position.

In some embodiments, the first cam is adapted to be moved from its firstposition to its second position independently of movement of the secondcam from its first position to its second position. In some embodiments,the second cam is adapted to be moved from its first position to itssecond position independently of movement of the second cam from itsfirst position to its second position.

In yet another example, the steering mechanism can further comprise aBowden cable disposed over a portion of a wire coupled to the actuator.The Bowden cable is adapted to move relative to the wire when the wireis moved in response to movement of the actuator.

In some embodiments, the actuation system is adapted for one-fingeredoperation by a user. In some embodiments, the actuator is movable in thefirst direction along the first axis and in the first direction alongthe second axis substantially simultaneously.

In another aspect, the invention generally involves a steering mechanismfor use with or as part of a medical device and that includes a housing,an actuator, a first cam, and a second cam. The housing is adapted to becoupled to a medical device including a steerable portion. At least aportion of the housing extends along a first axis. The actuator iscoupled to the housing and is movable with respect to the housing in afirst direction about the first axis. The actuator is movable withrespect to the housing in a first direction about a second axisdifferent than the first axis. The first cam is movable in response tomovement of the actuator in the first direction about the second axis.The first cam is adapted to move the steerable portion of the medicaldevice along a first plane. The second cam is movable in response tomovement of the actuator in the first direction about the first axis.The second cam is adapted to move the steerable portion of the medicaldevice along a second plane different than the first plane.

Embodiments according to this other aspect of the invention can includevarious features. For example, the actuator can be adapted forone-fingered operation by a user. The actuator can be adapted to controlmovement of the steerable portion of the medical device along the firstplane and the second plane such that 360 degree articulation of aportion of the steerable portion is achievable.

In another example, the first cam can be adapted to move about the firstaxis and the second axis different than the first axis.

In another example, the steering mechanism further comprises aprotrusion that is adapted to engage a portion of the second cam as theactuator moves in the first direction about the first axis. Theprotrusion can be adapted to move the second cam from a first positionto a second position different than the first position. The second camcan be adapted to move the steerable portion of the medical device in afirst direction along the second plane as the second cam moves from itsfirst position to its second position.

In yet another example, the steering mechanism further comprises a wireand a Bowden cable. The wire is coupled to the actuator and is adaptedto move the steerable member of the medical device. The Bowden cable isdisposed over at least a portion of the wire. The wire is movable withrespect to the Bowden cable.

In still another example, the elongate housing is adapted to beselectively held in a substantially horizontal orientation and asubstantially vertical orientation during operation of the steeringmechanism to control movement of the steerable member in a body of apatient.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic illustration of a steering mechanism for use withor as part of a medical device according to an embodiment of theinvention.

FIG. 2 is a schematic illustration of a medical device according to anembodiment of the invention.

FIG. 3 is a perspective view of a medical device according to anembodiment of the invention.

FIG. 4 is a top view of the medical device of FIG. 3.

FIG. 5 is a side view of the medical device of FIG. 3 being held in ahorizontal orientation by a hand of a user.

FIG. 6 is a side view of the medical device of FIG. 3 being held in avertical orientation by a hand of a user.

FIGS. 7 and 8 are side and perspective views, respectively, of a portionof a steering mechanism of the medical device of FIG. 3 with a portionof the elongate housing removed.

FIG. 8A is a perspective view of a portion of the steering mechanism ofthe medical device of FIG. 3.

FIGS. 9-11 are side views of the medical device of FIG. 3 in a first,second, and third configuration, respectively.

FIGS. 12-14 are side views of the medical device of FIG. 3 in a first,second, and third configuration, respectively.

FIG. 15 is a side view of a portion of the medical device of FIG. 3 witha portion of the elongate housing removed.

FIG. 16 is a top view of a steering mechanism according to an embodimentof the invention.

FIGS. 17 and 18 are perspective views of a portion of the steeringmechanism of FIG. 16 with a portion of the elongate housing removed.

FIGS. 19-22 are perspective views of a portion of the steering mechanismof FIG. 16 with a portion of the elongate housing removed and in a firstconfiguration, a second configuration, a third configuration, and afourth configuration, respectively.

FIG. 23 is a top view of a portion of the steering mechanism of FIG. 16with the second cam and a portion of the housing removed.

FIG. 24 is a side view of a portion of the steering mechanism of FIG. 16with a portion of the elongate housing removed.

DESCRIPTION

Apparatuses for controlled articulation of a steerable device aredescribed herein. For example, in some embodiments, the apparatus is asteering mechanism for use as part of a medical device. The steeringmechanism can be used as part of or with a medical device including asteerable member or portion, such as, for example, a catheter orendoscope.

In one embodiment, as schematically illustrated in FIG. 1, the apparatus110 is a steering mechanism. The steering mechanism 110 includes anelongate housing 112 and an actuator 122. The elongate housing 112 (alsoreferred to herein as “housing”) is configured to be coupled to a deviceincluding a steerable member (not illustrated in FIG. 1).

The elongate housing 112 includes a first grip portion 118 and a secondgrip portion 120 different than the first grip portion. The elongatehousing 112 is adapted to be held by a single hand of a user. Theelongate housing 112 is adapted to be held in at least two orientationsduring use, as described in more detail herein. For example, theelongate housing 112 is adapted to be in a first orientation whenoperatively held by the first grip portion 118 of the elongate housing.The elongate housing 112 is adapted to be in a second orientationdifferent than the first orientation when operatively held by the secondgrip portion 120 of the elongate housing. The phrase “operatively held”as used herein means when a user holds the device in a manner consistentwith the intended use and operation of the device; for example, as theuser would hold the device while using the device to treat a patient.

The elongate housing 112 includes a proximal end portion 114 and adistal end portion 116. At least a portion of the elongate housing 112substantially extends along an axis L.

The actuator 122 is coupled to the elongate housing 112. In theembodiment illustrated in FIG. 1, the actuator 122 is coupled to aportion of the elongate housing 112 between the first grip portion 118and the second grip portion 120 of the elongate housing.

The actuator 122 is adapted for one-fingered operation by a user. Theactuator 122 is adapted to control movement of a portion of a steerablemember of a medical device along at least a first plane and a secondplane different than the first plane such that the portion of thesteerable member of the medical device is movable in substantially anydirection 360 degrees around a central axis (not illustrated in FIG. 1).

In FIG. 2, the apparatus 200 is a steerable medical device (alsoreferred to herein as “medical device” or “steerable device”). Thesteerable medical device 200 includes an elongate member 202 (alsoreferred to herein as “steerable member”) and a steering mechanism 210.

The steering mechanism 210 is substantially similar to the steeringmechanism 110 described above and with reference to FIG. 1. The steeringmechanism 210 is adapted to control movement (or articulation) of atleast a portion of the elongate member 202. The steering mechanism 210is adapted to move the portion of the elongate member 202 along thefirst plane and the second plane.

The elongate member 202 includes a proximal end portion 204 and a distalend portion 206 and defines a lumen 203 therethrough. At least a portionof the elongate member 202 is configured to be steerable. Said anotherway, in some embodiments, the elongate member 202 includes a steerableportion 208. As described in more detail below, the steerable portion208 of the elongate member 202 is movable along the first plane and thesecond plane. For example, in some embodiments, the steerable portion208 is movable along a vertical plane and a horizontal plane.

In some embodiments, the elongate member 202 is a catheter or endoscope.For example, the elongate member can be a ureteroscope, boroscope, orcolonoscope. Because the elongate member 202 is movable along the firstplane and the second plane different than the first plane, a user cansteer the elongate member through tortuous paths within a body of apatient. For example, the user can selectively operate the steerabledevice 200 to navigate a catheter through a tortuous bodily vessel.

The steering mechanism 210 is coupled to the elongate (or steerable)member 202. The steering mechanism 210 includes an elongate housing 212and an actuator 222. The elongate housing 212 includes a proximal endportion 214 and a distal end portion 216. In the embodiment illustratedin FIG. 2, the distal end portion 216 of the elongate housing 212 iscoupled to the proximal end portion 204 of the elongate member 202.

In some embodiments, the steering mechanism 210 is adapted for at leastone of one-handed or one-fingered operation by a user. Said another way,a user can manipulate or control articulation of the steerable portion208 of the elongate member 202 by operating the steering mechanism 210with a single hand or finger.

For example, the user can selectively hold the steering mechanism 210 bya first grip portion 218 or a second grip portion 220. While holdingeither the first grip portion 218 and the second grip portion 220 withhis hand, the user can place a finger of the same hand holding theelongate housing 212 on the actuator 222. The actuator 222 is movable(or operable) by the single finger of the user. As used herein, the word“finger” means any digit of a person's hand, including the thumb.

The actuator 222 is movable with respect to the elongate housing 212 inat least a first direction along axis L. As described in more detailherein, movement of the actuator 222 in the first direction along axis Lmoves at least a portion of the elongate member 202 in a first directionalong the first plane (e.g., the steerable portion 208 of the elongatemember 202).

The actuator 222 is movable with respect to the elongate housing 212 inat least a first direction along a different axis, axis Q, than axis L(or about axis L). For example, axis Q can be transverse orsubstantially normal to axis L, as illustrated in FIG. 2. Movement ofthe actuator 222 in the first direction along axis Q moves at least aportion of the elongate member 202 in a first direction along the secondplane.

As illustrated in FIGS. 3 and 4, an apparatus 300, or steerable medicaldevice, according to an embodiment of the invention includes an elongatemember 302 (also referred to herein as “steerable member”) and asteering mechanism 310. The steering mechanism 310 substantially extendsalong axis L. The elongate member 302 substantially extends along acentral axis. In the embodiment illustrated in FIG. 4, the central axisis axis L. In other embodiments, the central axis and axis L can becoaxial or non-coaxial.

As illustrated in FIG. 4, the elongate member 302 substantially extendsalong the central axis when the elongate member is in a non-articulated(or linear) position (also referred to as the “first position”). In someembodiments, the elongate member 302 is biased towards a linear orrelaxed position.

Note that the illustrations in the figures are representative only, andare not drawn to scale. For example, in some embodiments, the elongatemember is a catheter or endoscope of greater length (such as compared tothe length of the steering mechanism) than the elongate member in theillustrated embodiment.

The elongate member 302 includes a proximal end portion 304 and a distalend portion 306 and defines a lumen 303 (illustrated in FIG. 5) at leastpartially therethrough. At least a portion of the elongate member 302 isa steerable portion 308. At least a portion of the steerable portion 308is movable along at least a first plane and a second plane differentthan the first plane, such that the portion of the steerable portion 308of the elongate member 302 is movable in substantially any direction 360degrees around the central axis C.

The steering mechanism 310 is adapted to control movement (orarticulation) of at least a portion of the elongate member 302 of thedevice 300. For example, in some embodiments, the steering mechanism 310is configured to move the steerable portion 308 of the elongate member302 along the first plane and along the second plane different than thefirst plane.

The steering mechanism 310 is adapted to be coupled to the elongatemember 302. In some embodiments, the steering mechanism 310 is removablycoupled to the elongate member 302.

The steering mechanism 310 includes an elongate housing 312 and anactuator 322. The elongate housing 312 includes a proximal end portion314 and a distal end portion 316. The elongate housing 312 of thesteering mechanism 310 is couplable to the elongate member 302. Asillustrated in FIGS. 3 and 4, the distal end portion 316 of the elongatehousing 312 is coupled to the elongate member 302.

The elongate housing 312 includes a first grip portion 318 and a secondgrip portion 320 different than the first grip portion. Each of thefirst grip portion 318 and second grip portion 320 is adapted to be heldor grasped by a hand of a user. The elongate housing 312 is adapted tobe in a first orientation when the first grip portion 318 is operativelyheld by the hand of the user. For example, as illustrated in FIG. 5,when the user holds the elongate housing 312 of the steering mechanism310 by the first grip portion 318, the elongate housing (and thesteering mechanism) is in a substantially horizontal orientation. Theuser can operate the actuator 322 with a single finger of the handholding the first grip portion 318.

The elongate housing 312 is adapted to be in a second orientationdifferent than the first orientation when the second grip portion 320 isheld by the hand of the user. For example, as illustrated in FIG. 6,when the user holds the elongate housing 312 of the steering mechanism310 by the second grip portion 320, the elongate housing (and thesteering mechanism) is in a substantially vertical orientation. The usercan operate the actuator 322 with a single finger of the hand holdingthe second grip portion 320.

At least one of the first grip portion 318 and the second grip portion320 can be contoured. For example, a contoured first or second gripportion 318, 320 can provide a more ergonomic handle for the steeringmechanism 310. As illustrated in FIGS. 3-6, the first grip portion 318and the second grip portion 320 are each contoured. The first and secondgrip portions 318, 320 each define a waist in the elongate housing 312.

In some embodiments, the first and second grip portions 318, 320 aresimilar in size and/or shape. In other embodiments, the first and secondgrip portions 318, 320 are different in size and shape. For example, insome embodiments, only one of the first or second grip portions iscontoured. In still other embodiments, no portion of the elongatedmember defines a contour, waist, or curve.

At least a portion of the elongate housing 312 substantially extendsalong axis L. As illustrated in FIGS. 4 and 5, a portion of the elongatehousing 312 including the distal end portion 316 of the elongate housingextends along axis L.

In some embodiments, the elongate housing 312 is constructed such thatthe proximal end portion 314 of the elongate housing is offset from axisL. For example, as illustrated in FIG. 5, at least a portion of theelongate housing 312 including the proximal end portion 314 of theelongate housing substantially extends along an axis D different thanaxis L. In some embodiments, the elongate housing 312 is curved orincludes a curved portion such that a portion of the elongate housing isoffset from the axis L and/or extends along axis A_(D). As illustratedin FIG. 5, the elongate housing 312 can be substantially similar inshape to a pistol or handgun.

As illustrated in FIGS. 7 and 8, the elongate housing 312 defines acavity 324. In some embodiments, the cavity 324 extends from theproximal end portion 314 to the distal end portion 316 of the elongatehousing 312. In some embodiments, at least a portion of the actuator 322is disposed in the cavity 324 of the elongate housing 312. For example,as illustrated in FIGS. 7 and 8, the actuator 322 includes a stem 326that extends from a finger rest portion 328 of the actuator 322 exteriorto the elongate housing 312 into the cavity 324 of the elongate housing.The elongate housing 312 defines an opening through which the stem 326of the actuator 322 extends. Although the finger rest portion 328 isillustrated in the shape of a button in FIGS. 7 and 8, in otherembodiments, the finger rest portion can be any known shape. Theactuator 322 is adapted for one-fingered use by the user.

The actuator 322 is coupled to the elongate housing 312. In theillustrated embodiment, the actuator 322 is coupled to a portion of theelongate housing 312 between the first grip portion 318 and the secondgrip portion 320 of the elongate housing.

The actuator 322 is adapted to control movement of a portion of thesteerable member 302 of the medical device 300 along at least the firstplane and the second plane. As such, the actuator 322 can controlmovement of the steerable portion 308 of the steerable member 302 insubstantially any direction 360 degrees around the central axis C.

The actuator 322 is movable in at least a first direction along axis L.As described in more detail below, movement of the actuator 322 in thefirst direction along axis L moves the steerable portion 308 of themedical device 300 in a first direction along the first plane. Forexample, in some embodiments, the first plane is a vertical plane, andthus movement of the actuator 322 in the first direction along axis Lmoves the steerable portion 308 in the first direction along thevertical plane (e.g., “up”).

The actuator 322 is movable in a second direction different than thefirst direction along the axis L. For example, the actuator 322 can bemoved in a second direction that is opposite the first direction alongaxis L. Movement of the actuator 322 in the second direction along axisL moves the steerable portion 308 of the medical device 300 in a seconddirection different than the first direction along the first plane. Forexample, movement of the actuator 322 in the second direction along axisL moves the steerable portion 308 in the second direction along thevertical plane (e.g., “down”).

The actuator is movable in at least a first direction along axis Q (orabout or around the axis L). As described in more detail below, movementof the actuator 322 in the first direction along axis Q moves thesteerable portion of the medical device in at least a first directionalong the second plane. For example, in some embodiments, the secondplane is a horizontal plane, and thus movement of the actuator 322 inthe first direction along axis Q moves the steerable portion 308 in thefirst direction along the horizontal plane (e.g., to the right).

The actuator 322 is movable in a second direction different than thefirst direction along axis Q. For example, the actuator 322 can be movedin a second direction that is opposite the first direction along axis Q.Movement of the actuator 322 in the second direction along axis Q movesthe steerable portion 308 of the medical device 300 in a seconddirection along the second plane different than the first direction. Forexample, movement of the actuator 322 in the second direction along axisQ moves the steerable portion 308 in the second direction along thehorizontal plane (e.g., to the left).

In some embodiments, as illustrated in FIGS. 7 and 8, the actuator 322is included in an actuation system 370 of the steering mechanism 310.The actuation system 370 is adapted to control articulation of thesteerable member 302. The actuation system 370 of the steering mechanism310 includes the actuator 322, a first cam 330, a second cam 350, andfirst, second, third, and fourth wires 332, 334, 352, 354, or anycombination of the foregoing.

The first cam 330 moves in response to movement of the actuator 322. Thefirst cam 330 is adapted to move the steerable portion 308 of themedical device 300 along the first plane when the first cam moves inresponse to movement of the actuator 322.

As illustrated in FIG. 7, the first cam 330 is at least partiallydisposed in the cavity 324 of the elongate housing. The first cam 330 iscoupled to the elongate housing 312 by a frame 336. The frame 336 iscoupled to an inner surface of the elongate housing 312 defining thecavity 324. In the embodiment illustrated in FIGS. 7 and 8, the frame336 includes a first supporting arm 342, a second supporting arm 344,and a central arm 346. The first supporting arm 342 and secondsupporting arm 344 are each coupled to the elongate housing 312. Thecentral arm 346 extends between and is coupled to the first and secondsupporting arms 342, 344.

In the embodiment illustrated in FIG. 8A, the central arm 346 defines anopening or pocket adapted to receive a portion of the first cam 330. Thefirst cam 330 is coupled to the central arm 346. The first cam 330 canbe coupled to the central arm 346 by any known coupling mechanism,including, but not limited to, a pin or other mechanical fastener.

The first cam 330 is movable with respect to the frame 336. The firstcam 330 is movable between at least a first position (illustrated inFIG. 7) and a second position different than the first position. In theembodiment illustrated in FIGS. 7-11, the first cam 330 is movablebetween at least the first position, the second position, and a thirdposition different than the first and second positions, as describedherein.

The first cam 330 is coupled to the actuator 322. In some embodiments,as illustrated in FIGS. 7 and 8, the first cam 330 is fixedly coupled tothe stem 326 of the actuator 322.

The first cam 330 is coupled to each of the first wire 332 and thesecond wire 334. As illustrated in FIGS. 7 and 8, the first and secondwires 332, 334 are coupled to the first cam 330 at spaced locations. Thefirst wire 332 can be coupled to the first cam 330 proximate to theactuator 322. In the embodiment illustrated in FIG. 7, the second wire334 is coupled to a portion of the first cam 330 different than theportion of the cam coupled to the first wire 332. The first wire 332 andthe second wire 335 are each adapted to move in response to movement ofthe first cam 330. Additionally, the first and second wires 332, 334 areeach coupled to the elongate member 302 of the medical device 300. Thus,movement of the first and second wires 332, 334 moves the elongatemember 302, as described in more detail herein.

Referring to FIGS. 7 and 9-11, as the actuator 322 is moved in its firstdirection along axis L (as indicated by arrow A.sub.1), the first cam330 correspondingly moves to a second position different than its firstposition. As the first cam 330 moves towards its second position, thefirst cam moves (or pulls on) the first wire 332. The first wire 332moves the steerable portion 308 of the elongate member 302 in its firstdirection along the first plane (e.g., “up”).

To return the elongate member 302 to its starting position (or thelinear or relaxed position), the actuator 322 is moved in its seconddirection until the first cam 330 is moved (or returned) to its firstposition. In some embodiments, at least one of the actuator 322 and thefirst cam 330 is biased towards a first (or starting) position.

As the actuator 322 is moved in its second direction along axis L (asindicated by arrow A.sub.2), the first cam 330 correspondingly moves toa third position different than its first and second positions. As thefirst cam 330 moves from its first position towards its third position,the cam moves (or pulls on) the second wire 334. The second wire 332moves the steerable portion of the elongate member 302 in its seconddirection along the first plane (e.g., “down”).

The first cam 330 is adapted to introduce force leverage (or amechanical advantage) to help move the elongate member 302 along thefirst plane when the steering mechanism 310 is operated. Because thefirst cam 330 moves by rotating about axis Q, the first cam is adaptedto introduce force leverage; for example, to the first wire 332 and/orthe second wire 334 as the first cam moves between its first, second,and/or third positions.

The second cam 350 is adapted to move the steerable portion 308 of themedical device 300 along the second plane when the second cam moves inresponse to movement of the actuator 322. As illustrated in FIGS. 7 and8, the second cam 350 is at least partially disposed in the cavity 324of the elongate housing 412.

The second cam 350 is coupled to the elongate housing 312 by a centralaxle 338 (e.g., a cantilever axle). The central axle 338 is coupled tothe elongate housing 312 (not shown because that portion of the elongatehousing is removed in FIGS. 7 and 8). The central axle 338 extends alongaxis Q (illustrated in FIG. 4). In the embodiment illustrated in FIGS. 7and 8, the central axle 338 extends through a portion of the second cam350, such as through a central portion of the second cam. The second cam350 is movable about (or around) the central axle 338 (and thus aboutaxis Q, illustrated in FIG. 4), as described in more detail herein.

As described above, the frame 336, which is coupled to the first cam330, includes the central arm 346. The central arm 346 is movable withrespect to the first and second supporting arms 342, 344. As illustratedin FIGS. 7 and 8, the central arm 346 is adapted to rotate about a firstend axle 343 (shown in dashed lines in FIG. 8A) associated with thefirst supporting arm 342 and about a second end axle 345 (shown indashed lines in FIG. 8A) associated with the second supporting arm 344.As such, the central arm 346 of the frame 336 can rotate about (or withrespect to) axis L. Because the central arm 346 is coupled to the firstcam 330, which is coupled to the actuator 322, the central arm is movedor rotated about axis L by moving the actuator along axis Q (or aboutaxis L) in the first direction or in the second direction different thanthe first direction along axis Q.

The steering mechanism 310 includes a protrusion 348. In someembodiments, the protrusion 348 extends from the central arm 346 of theframe 336. In the embodiment illustrated in FIGS. 7 and 8, theprotrusion is a swivel pin 348 disposed on and extending from thecentral arm 346 of the frame 336. Because the swivel pin 348 is disposedon the central arm 346, the swivel pin moves with the central arm 346when the central arm moves in response to movement of the actuator 322.

The swivel pin 348 extends from the central arm 346 at least partiallythrough a recess 356 (or aperture) defined by the second cam 350. Theswivel pin 348 is adapted to move the second cam 350 as the swivel pinis moved in response to movement of the actuator 322. Although theprotrusion is illustrated and described as being a swivel pin 348, inother embodiments, the protrusion can have any known configuration orshape suitable for extending through the recess defined by the secondcam and/or for moving the second cam.

The second cam 350 is movable between at least a first position(illustrated in FIGS. 7 and 8) and a second position different than thefirst position. In the embodiment illustrated in FIGS. 7 and 8, thesecond cam 350 is movable between at least the first position, secondposition, and a third position different than the first and secondpositions, as described in more detail below.

The second cam 350 is coupled to each of the third wire 352 and thefourth wire 354. As illustrated in FIGS. 7 and 8, the third and fourthwires 352, 354 are coupled to the second cam 350 at spaced locations.The third wire 352 and the fourth wire 354 are each adapted to move inresponse to movement of the second cam 350. Additionally, the third andfourth wires 352, 354 are each coupled to the second cam 350 and to theelongate member 302. Thus, movement of the second and third wires 352,354 moves the elongate member 302, as described in more detail herein.

Referring to FIGS. 7-8 and 12-14, as the actuator 322 is moved in itsfirst direction along axis Q (or about axis L), as indicated by arrowA₃, the central arm 346 of the frame 336 moves (or rotates) in a firstdirection A₁ about axis L A_(N) and about the first and second end axles343, 345 associated with the first and second supporting arms 342, 344,respectively.

The swivel pin 348 disposed on the central arm 346 moves with thecentral arm in the first direction. For example, in some embodiments,the central arm 346 rotates downwardly when moved in the firstdirection. As the swivel pin 348 moves in its first direction, theswivel pin contacts or engages a first surface area 357 of the secondcam 350 defining the recess 356. As the swivel pin 348 continues movingin its first direction, the swivel pin pushes against, or otherwiseapplies force to, the first surface area 357 of the recess 356, and thuscauses the second cam 350 to rotate about the central axle 338 and movefrom its first position towards its second position.

As the second cam 350 moves towards its second position, the second cammoves (or pulls on) the third wire 352. Because the third wire 352 isalso coupled to the elongate member 302, the third wire moves thesteerable portion 308 of the elongate member in its first directionalong the second plane (e.g., to the right).

To return the elongate member 302 to its starting or relaxed position,the actuator 322 is moved in its second direction along axis Q (or aboutaxis L) until the second cam 350 is moved (or returned) to its firstposition. In some embodiments, the second cam 350 is biased towards itsfirst (or starting) position.

As the actuator 322 is moved in its second direction along axis Q (orabout or around axis L), as indicated by arrow A₄, the central arm 346of the frame 336 moves (or rotates) in a second direction different thanthe first direction about axis L and about the axles 343, 345 associatedwith the first and second supporting arms 342, 344. For example, in someembodiments, the central arm 346 rotates upwardly when moved in thesecond direction.

The swivel pin 348 disposed on the central arm 346 moves with thecentral arm in the second direction. As the swivel pin 348 moves in itssecond direction, the swivel pin contacts or engages a second surfacearea 358 of the second cam 350 defining the recess 356. As the swivelpin 348 continues moving in its first direction, the swivel pin pushesagainst, or otherwise applies force to, the second surface area 358 ofthe recess 356, and thus causes the second cam 350 to rotate about thecentral axle 338 and move from at least one of its first position or itssecond position to or towards its third position.

As the second cam 350 moves towards its third position, the second cammoves (or pulls on) the fourth wire 354. Because the fourth wire 354 isalso coupled to the elongate member 302, the fourth wire 354 moves thesteerable portion 308 of the elongate member 302 in its second directionalong the second plane (e.g., to the left).

The second cam 350 is adapted to introduce force leverage (or amechanical advantage) to help move the elongate member 302 along thesecond plane when the steering mechanism 310 is operated. Because thesecond cam 350 moves by rotating about axis Q, the second cam is adaptedto introduce force leverage; for example, to the third wire 352 and/orthe fourth wire 354 as the second cam moves between its first, second,and/or third positions.

As the actuator 322 moves in its first direction or its second directionalong axis Q (or about axis L), the first cam 330 also correspondinglymoves in the same direction. This movement, however, does notnecessarily cause the first cam 330 to move between its first, second,or third positions. Thus, movement of the actuator to move the steerableportion 308 of the elongate member 302 along the second plane does notnecessarily also move the steerable portion along the first plane. As aresult, the first cam 330 and the second cam 350 are independentlyactuatable (or movable) between their respect first, second, and thirdpositions.

Although the first cam 330 and the second cam 350 are independentlyactuatable, as previously described, a user can selectively actuate thefirst and second cams substantially simultaneously. For example, thefirst and second cams 330, 350 can be actuated substantiallysimultaneously by moving the actuator 322 along axis L and axis Q atsubstantially the same time. Movement of the actuator 322 along axis Land axis Q at substantially the same time results in movement of theactuator along a third axis different than axis L and axis Q. Forexample, the third axis can be at a 45 degree angle to axis : and/oraxis Q. As the actuator 322 moves along the third axis, the first andsecond cams 330, 350 are substantially simultaneously moved, and thusthe steerable portion 308 of the elongated member 302 is moved on athird plane different than the first and second planes. For example, thethird plane can be at a 45 degree angle to the first and second planes.

In some embodiments, as illustrated in FIGS. 5 and 15, the apparatus 300includes a port 362. The port 362 is adapted to be connected to aworking channel 366, or lumen, that extends through at least a portionof the elongate member 302 of the medical device 300 to or towards thedistal end portion 306 of the elongate member 302. In some embodiments,the working channel 366 extends to or towards a treatment site in a bodyof a patient. The port 362 is adapted to receive medicalinstrumentation. For example, in some embodiments, the port 362 isadapted to receive at least one of a guidewire, laser fiber, stonebasket, biopsy device, or other medical instrumentation. The port 362allows a user to insert the medical instrumentation into the workingchannel 366, and then through the elongate member 302 to the treatmentsite. In one procedure, for example, a portion of a guidewire is passedthrough the port 462, through the working channel 366, and to thetreatment site.

FIGS. 16-24 illustrate a steering mechanism 410 according to anotherembodiment of the invention. The steering mechanism 410 is adapted tocontrol movement (or articulation) of at least a portion of a steerablemember of a medical device (not shown in FIGS. 16-24), such as theelongated member 302 described above. In some embodiments, the steeringmechanism 410 is configured to move the steerable member along a firstplane and along a second plane different than the first plane such that360 degree articulation of the steerable member is achievable.

The steering mechanism 410 is adapted to be coupled to the steerablemember. In some embodiments, the steering mechanism 410 is removablycoupled to the steerable member. The steering mechanism 410 includes anelongate housing 412 and an actuation system 470.

The elongate housing 412 includes a proximal end portion 414 and adistal end portion 416. The elongate housing 412 of the steeringmechanism 410 is couplable to the steerable member. For example, adistal end portion 416 of the elongate housing 412 (illustrated in FIG.16) is adapted to be coupled to the steerable member. The distal endportion 416 of the elongate housing 412 is couplable to the steerablemember by any known coupling mechanism, including, but not limited to,an interference fit, an adhesive, mating recesses, or the like, or anycombination of the foregoing.

The elongate housing 412 is similar in many respects to the elongatehousing 312 previously described in reference to FIGS. 3 and 4. Forexample, the elongate housing 412 is adapted to be held by a user in atleast two different orientations. In another example, the elongatehousing 412 includes a portion substantially extending along axis L(shown in FIG. 23) and a portion substantially extending along an axisdifferent than axis L (not shown).

The actuation system 470 is coupled to and at least partially disposedwithin the elongate housing 412. The actuation system 470 is adapted tocontrol movement of a steerable portion of the medical device along atleast the first plane and the second plane different than the firstplane. The actuation system 470 is also adapted for one-fingeredoperation by a user.

Referring to FIGS. 16-23, the actuation system 470 includes an actuator422, a first cam 430, a second cam 450, first and second Bowden cables474, 476, respectively, a coupling 444, a protrusion 448, and first,second, third, and fourth wires 432, 434, 452, 454, respectively. Inother embodiments, the actuation system can include any combination ofthe foregoing.

The actuator 422 is coupled to the elongate housing 412. In theillustrated embodiment, the actuator 422 is coupled to a portion of theelongate housing 412 between a first grip portion 418 and a second gripportion 420 of the elongate housing. The actuator 422 is movable withrespect to the elongate housing 412.

The actuator 422 is adapted for one-fingered use by the user. Theactuator 422 is adapted to control movement of a portion of thesteerable member of the medical device along at least the first planeand the second plane. As such, the steerable portion 408 of thesteerable member is movable in substantially any direction 360 degreesaround the central axis C.

In the embodiment illustrated in FIGS. 16-23, the actuator 422 includesa finger rest portion 428 and a stem 426. The finger rest portion 428 isillustrated as being substantially U-shaped, however, in otherembodiments, the finger rest portion can be any known shape suitable foruse as part of a medical device. The U-shape (or contour) of the fingerrest portion 428 allows a user's finger to rest easily and comfortablyon the actuator 422. The contour of the finger rest portion 428 isadapted to help prevent the user's finger from slipping off of eitherside of the finger rest portion of the actuator. The stem 426 couplesthe finger rest portion 428 of the actuator 422 to the actuation system470 and the elongate housing 412.

The actuator 422 is adapted to move along axis L and along axis Qdifferent than axis L, as illustrated in FIGS. 17 and 23. As describedherein, the actuator 422 is adapted to move each of the first cam 430and the second cam 450. The first cam 430 is adapted to move thesteerable member of the medical device along the first plane when thefirst cam 430 is moved by the actuator 422. The second cam 450 isadapted to move the steerable member of the medical device along thesecond plane when the second cam 450 is moved by the actuator 422.

As illustrated in FIG. 17, the first cam 430 is at least partiallydisposed in a cavity 424 defined by the elongate housing 412. The firstcam 430 is coupled to the elongate housing 412. As illustrated in FIG.23, in some embodiments, the first cam 430 is coupled to the elongatehousing 412 by an axle 438 (a portion of which is shown in dashedlines). In some embodiments, the axle 438 is a cantilever axle. The axle438 extends from the elongate housing 412 along axis Q into the cavity424 of the elongate housing. The axle 438 at least partially extendsthrough an opening (not shown) defined by the first cam 430. The firstcam 430 is movable about (or around) axis Q along which the axle 438extends, as described in more detail below. The first cam 430 is movablebetween at least a first position (illustrated in FIGS. 17 and 18) and asecond position (illustrated in FIG. 19) different than the firstposition. In the embodiment illustrated in FIGS. 17 and 18, the firstcam 430 is movable between at least the first position, the secondposition different than the first position, and a third position(illustrated in FIG. 20) different than the first and second positions,as described in more detail below.

The first cam 430 is coupled to a second axle 440 of the steeringmechanism 410. The axle 440 is disposed within the cavity 424 defined bythe elongate housing 412. In the embodiment illustrated in FIG. 23, theaxle 440 extends along axis L. The actuator 422 is coupled to the axle440 by a coupling 444. As illustrated in FIG. 23, in some embodiments,the coupling 444 is disposed over at least a portion of the axle 440.

As the actuator 422 is moved in its first direction (e.g., as indicatedby arrow A.sub.5 in FIG. 19) along axis L (or about axis Q), thecoupling 444 is moved in the first direction, thus the axle 440 is movedin the first direction and the first cam 430, which is coupled to theaxle 440, is moved (or rotated) about axis Q from its first position(illustrated in FIG. 18) to its second position (illustrated in FIG.19). In other words, movement of the actuator 422 in its first directionalong axis L moves the first cam 430 from its first position to itssecond position.

The first wire 432 and the second wire 434 are each coupled to the firstcam 430. In the embodiment illustrated in FIGS. 17 and 18, the firstwire 432 and the second wire 434 are coupled to the first cam 430 atspaced locations. Each of the first wire 432 and the second wire 434 isadapted to move in response to movement of the first cam 430. The firstand second wires 432, 434 are each also coupled to the steerable member(not illustrated).

As the first cam 430 moves about axis Q from its first position to ortowards its second position, the first cam moves (or pulls on) the firstwire 432, and thus the first wire 432 moves the steerable portion of thesteerable member in its first direction along the first plane (e.g.,“up”).

To return the steerable member to its starting or relaxed position, theactuator 422 is moved in its second direction (e.g., as indicated byarrow A₆ in FIG. 20) until the first cam 430 is moved (or returned) toits first position. In some embodiments, at least one of the actuator422 and the first cam 430 is biased towards a first (or starting)position.

As the first cam 430 moves from its first position towards its thirdposition, the first cam moves (or pulls on) the second wire 434. Thesecond wire 432 moves the steerable portion of the steerable member inits second direction along the first plane (e.g., “down”).

As illustrated in FIGS. 17 and 18, the second cam 450 is disposed in thecavity 424 of the elongate housing 412. The second cam 450 is at leastpartially disposed over the axle 438. Said another way, the axle 438 atleast partially extends through a portion of or opening defined by thesecond cam 450, such as a central portion of the second cam. The secondcam 450 is adapted to rotate about axis Q along which the axle 438extends. For example, as the first cam 430 is moved in the firstdirection from its first position and its second position and/or in thesecond direction from its second position to its first position and/orits third position, the second cam 450 correspondingly moves about axisQ in the first direction and/or the second direction. In this manner,and as described in more detail herein, the relative position of theBowden cables 474, 476, which are coupled to the first cam 430, remainssubstantially the same with respect to the third and fourth wires 452,454, which are coupled to the second cam 450, when the first cam ismoved between its first position, second position, and/or third positionand the second cam is correspondingly moved in the first directionand/or the second direction. In this manner, articulation of thesteerable member of the medical device along the second plane issubstantially unaffected by rotation of the second cam 450 about axis Q,that corresponds with rotation of the first cam 430 about axis Q.

The second cam 450 is movable between at least a first position(illustrated in FIGS. 17 and 18) and a second position (illustrated inFIG. 21) different than the first position. In the embodimentillustrated in FIGS. 16-23, the second cam 450 is movable between thefirst position, the second position, and a third position (illustratedin FIG. 22) different than the first and second positions, as describedherein.

The second cam 450 and the first cam 430 can be independently movable.For example, the second cam 450 is adapted to move the steerable memberalong the second plane when the second cam is moved (or rotated) aboutaxis Q independently of movement (or rotation) of the first cam 430about axis Q, as described herein.

As described above, the actuation system 470 includes the coupling 444.The coupling 444 is movable with respect to the axle 440. For example,the coupling 444 can be adapted to rotate with respect to (or about) theaxle 440 (and about axis L along which the axle 440 extends). In theembodiment illustrated in FIGS. 17-23, the coupling 444 is a T-shapedcoupling.

At least a portion of the coupling 444 is adapted to engage the secondcam 450. In the embodiment illustrated in FIG. 18, the protrusion 448 isa lever portion that extends from the coupling 444 at least partiallythrough a recess 456 (or aperture) defined by the second cam 450. Thelever portion 448 is adapted to move in response to movement of theactuator 422. The lever portion 448 is adapted to move the second cam450 as the lever portion moves in response to movement of the actuator422, as described in more detail herein.

The third wire 452 and the fourth wire 454 are each coupled to thesecond cam 450. In the embodiment illustrated in FIGS. 17 and 18, thethird and fourth wires 452, 454 are coupled to the second cam 450 atspaced locations. The third and fourth wires 452, 454 are each alsocoupled to the steerable member. The third and fourth wires 452, 454 areadapted to be moved by the second cam 450 and to move the steerablemember along the second plane in response to movement of the second cam.

At least a portion of each of the third and fourth wires 452, 454 aredisposed within a lumen defined by the first and second Bowden cables474, 476, respectively. The first and second Bowden cables 474, 476 areadapted to help transfer the point of relative motion from distal endportions of the third and fourth wires 452, 454 to a more proximalportion of the wires 452, 454. For example, the third wire 452 can moverelative to the first Bowden cable 474 to move (or articulate) thesteerable member in the first direction along the second plane.

The first and second Bowden cables 474, 476 can be constructed of anysuitable material. For example, the Bowden cables 474, 476 can be of acomposite construction, such as a spiral steel wire coated with plastic.The Bowden cables 474, 476 can include an outer sheath, such as aplastic outer sheath. The first Bowden cable 474 terminates on a portionof the first cam 430, as illustrated in FIG. 17. The second Bowden cable476 terminates on a portion of the first cam 430, as also illustrated inFIG. 17.

Referring to FIG. 21, as the actuator 422 moves in its first direction(e.g., as indicated by arrow A.sub.7) along axis Q (or about axis L),the coupling 444 rotates in a first direction about the axle 440 from afirst position to a second position different than the first position.As the coupling 444 rotates in the first direction to or towards itssecond position, the lever portion 448 moves in the first direction froma first position to or towards a second position different than itsfirst position. As the lever portion 448 moves to or towards its secondposition, the lever portion engages or contacts a first surface area 457of the second cam 450 at least partially defining a recess 456.

As the lever portion 448 continues moving in its first direction, thelever portion pushes against, or otherwise applies force to, the firstsurface area 457 of the second cam 450 defining the recess 456, and thuscauses the second cam 450 to move from its first position towards itssecond position.

As the second cam 450 moves towards its second position, the second cammoves (or pulls on) the third wire 452. Because the first cam 430 doesnot move about the axle 438 with the second cam 450, the first Bowdencable 474 remains relatively stationary and the third wire 452 moveswith respect to the first Bowden cable. The linear movement of the thirdwire 452 relative to the first Bowden cable 474 transmits a moving (orpulling) force to the third wire. Thus, the third wire 452 moves thesteerable member in its first direction along the second plane (e.g., tothe right).

To return the steerable member to the linear or relaxed position, theactuator 422 is moved in its second direction (e.g., as indicated byarrow A.sub.8 in FIG. 22) along axis Q (or about axis L) until thesecond cam 450 is moved (or returned) to its first position. In someembodiments, the second cam 450 is biased towards its first (orstarting) position.

Referring to FIG. 22, the second cam 450 is moved to or towards itsthird position by moving the actuator 422 in its second direction alongaxis Q. As the actuator moves in its second direction along axis Q, thecoupling 444 rotates in a second direction different than its firstdirection about the axle 440 from one of its first or second positionsto a third position different than its first or second positions. As thecoupling 444 rotates in the second direction to or towards its thirdposition, the lever portion 448 is moved in the second direction fromits first or second position to a third position different than itsfirst or second positions. As the lever portion 448 moves to or towardsits third position, the lever portion engages or contacts a secondsurface area 458 of the second cam 450 at least partially defining therecess 456.

As the lever portion 448 continues moving in its second direction, thelever portion pushes against, or otherwise applies force to, the secondsurface area 458 of the second cam 450, and thus causes the second camto move from at least one of its first or second positions to or towardsits third position.

As the second cam 450 moves towards its third position, the second cammoves (or pulls on) the fourth wire 454. Because the first cam 430 doesnot move about the axle 438 with the second cam 450, the second Bowdencable 476 remains relatively stationary and the fourth wire 454 moveswith respect to the second Bowden cable. The linear movement of thefourth wire 454 relative to the second Bowden cable 476 transmits amoving (or pulling) force to the fourth wire. Thus, the fourth wire 454moves the steerable portion 308 of the steerable member in its seconddirection along the second plane (e.g., to the left).

The steering mechanism 410 has been illustrated and described asincluding first and second Bowden cables 474, 476 associated withmovement of the steerable member along the second plane, however, inother embodiments, the Bowden cables can be associated with movement ofthe steerable member along the first plane. In such an embodiment, theBowden cables will terminate at a proximal end of each cable on an innerportion of the elongate housing. In other embodiments, the steeringmechanism can include any number of Bowden cables, such as a Bowdencable associated with each wire included in the steering mechanism, ornone.

Although the first and second Bowden cables 474, 476 terminate on thefirst cam 430, and thus move with the first cam when the first cam movesbetween its first, second, and third positions, there is no relativemovement between the third or fourth wire 452, 454 and their respectiveBowden cables because the second cam 450 also moves with the first camas the first cam moves in its first or second directions along axis L(or about axis Q). As such, movement of the first actuator to move thesteerable member along the first plane does not cause inadvertentmovement of the steerable member along the second plane.

Although the first cams 330, 430 have been illustrated as being largerin size than the second cams 350, 450, respectively, in otherembodiments, the first cam and second cam can each be a different size.For example, in one embodiment, the first and second cams are the samesize. In another example, the second cam is larger in size than thefirst cam.

Although the steering mechanism 310, 410 has been illustrated anddescribed as including first, second, third, and fourth wires 332, 334,352, 354 and 432, 434, 452, 454, respectively, in other embodiments, thesteering mechanism includes a different number of wires. For example, inone embodiment, the steering mechanism includes a first wire and asecond wire. In such an embodiment, the first wire is adapted to movethe steerable member along the first plane, and the second wire isadapted to move the steerable member along the second plane. Forexample, in one such embodiment, the ends of the first wire are coupledto a steerable member of a medical device and a portion of the firstwire between its ends is coupled to a first cam. In some embodiments, aportion of the first wire between its ends is wrapped around a portionof the first cam. As the first cam is moved between its first, secondand third positions, the first cam moves one of the ends of the firstwire coupled to the steerable member resulting in articulation of thesteerable member. The ends of the second wire are coupled to thesteerable member and a portion of the second wire between its ends iscoupled to a second cam. In some embodiments, a portion of the secondwire between its ends is wrapped around a portion of the second cam. Asthe second cam is moved between its first, second and third positions,the second cam moves one of the ends of the second wire coupled to thesteerable member resulting in articulation of the steerable member.

Although the steering mechanism 310, 410 has been illustrated anddescribed as moving the steerable (or elongate) member along a verticalplane and a horizontal plane, in other embodiments, the steeringmechanism moves the steerable member along at least two planes differentthan the vertical and horizontal planes.

In some embodiments, as illustrated in FIGS. 16 and 24, the steeringmechanism 410 includes a first port 462 and a second port 464. The firstport 462 is substantially similar to the first port 362 described abovewith reference to FIGS. 5 and 15. The second port 464 is adapted totransport an irrigation fluid, such as saline, or gas, such as an airjet, from a source external to the medical device 400 into the firstport 462. The second port 464 is fluidically connected to the first port462, which can be fluidically connected to the working channel 466extending at least partially through the elongate member. The irrigationfluid can be passed through the second port 464 to wash the medicalinstrumentation passed through the first port 462. In one procedure, forexample, an irrigation fluid is passed through the second port 464 towash off debris, such as from broken stones being removed from thetreatment site by a stone basket that has been passed through the firstport 462.

In the illustrated embodiment, the second port 464 extends radially fromthe first port 462. In some embodiments, the ports 462, 464 areconfigured with a Y-shaped junction, as illustrated in FIG. 24. One orboth of ports 462, 464 can be monolithically constructed with theelongate housing 412. In other embodiments, one or both of ports 462,464 can be separately constructed and then disposed on or coupled to theelongate housing 412. Although ports 462, 464 are illustrated as beingcoupled to the distal end portion 416 of the elongate housing 412, inother embodiments, the ports can be coupled to a different portion ofthe medical device 400.

Referring again to FIGS. 15 and 24, in some embodiments, the medicaldevice includes or is adapted to receive an electrical component (notshown). For example, the steering mechanism 310, 410 includes anelectrical port 368, 468. The electrical port 368, 468 is adapted forchanneling or receiving at least a portion of the electrical component.For example, in some embodiments, the electrical port is adapted toreceive at least a portion of a signal transmission line. In oneprocedure, the signal transmission line can extend from a point exteriorto the medical device, through the electrical port, and through theelongate member to or towards the distal end portion of the elongatemember. The signal transmission line, for example, can be adapted totransmit an image received by an optical element at the distal endportion of the transmission line to an imaging system exterior to themedical device. In another example, the electrical port is adapted toreceive at least a portion of an electrical component including a fiberoptic light and associated electrical cable. In some embodiments, theelectrical port is monolithically constructed with the elongate housing.In other embodiments, the electrical port is separately constructed andthen coupled to the elongate housing. Although the electrical port isillustrated as being coupled to the distal end portion of the elongatehousing, in other embodiments, the port can be coupled to a differentportion of the medical device.

Although the steering mechanism 310 is illustrated and described asincluding first port 362 and electrical port 368, and the steeringmechanism 410 is illustrated and described as including first port 462,second port 464, and electrical port 368, in other embodiments, asteering mechanism can include any combination of the first, second, andelectrical ports, only one of the first, second, or electrical ports, ornone.

In a procedure utilizing a steering mechanism according to the presentinvention, a user operatively holds the elongate housing of the steeringmechanism in a hand of the user. To hold the elongate housing, the usercan grasp one of the first grip portion or the second grip portion withthe user's hand. The user places a finger of the hand holding theelongate housing onto the actuator. For example, the user can place apad of the finger on the finger rest portion of the actuator.

The user moves the actuator with the finger on the actuator in a firstdirection along axis L defined by a portion of the elongate housing ofthe steering mechanism. Moving the actuator in the first direction alongaxis L includes moving a first cam in a first direction and moving asteerable portion of a medical device in a first direction along a firstplane. For example, to move the steerable member or portion of themedical device in a vertical direction, the user moves the actuatoralong axis L.

The user moves the actuator in a first direction along an axis differentthan axis L defined by a portion of the elongate housing of the steeringmechanism. For example, the user can move the actuator along an axistransverse to axis L. Moving the actuator in the first direction alongthe axis different than axis L includes moving a second cam in a firstdirection and moving the steerable portion of the medical device in afirst direction along a second plane different than the first plane. Forexample, to move the steerable member or portion in a horizontaldirection, the user moves the actuator to the left or to the right(along axis Q) from the perspective of the user.

The user can move the steerable member in a direction other than avertical or horizontal direction by moving the actuator along axis L andaxis Q substantially the same time. For example, the user cansubstantially simultaneously move the actuator along both of thelongitudinal and transverse axes to move the steerable member or portionat a 45 degree angle. The user can also achieve articulation of thesteerable member or portion at the 45 degree (or other) angle bysequentially moving the actuator along axis L and axis Q. The steeringmechanism is configured such that the user can control articulation ofthe steerable member or portion in substantially any angle or directionthat is 360 degrees about axis L. The 360 degree articulation allows theuser to approximate the distal end portion of the steerable member to adesired location within a body of a patient.

Although the features of the steerable medical device, and the steeringmechanism particularly, have been illustrated and described in certaincombinations, in other embodiments, individual features can be combinedor not included in a particular embodiment. For example, in anotherembodiment, the steering mechanism 310 can include Bowden cables likethose illustrated and described with respect to the steering mechanism410.

In another example, the steering mechanism 310 can include a protrusionthat is a lever portion similar to the lever portion 448 illustrated anddescribed with respect to the steering mechanism 410; for example,instead of the swivel pin 348. In a further example, the protrusion canbe disposed on a different portion of the steering mechanism; forexample, on the elongate housing.

Additionally, although the second axis has been illustrated as beingsubstantially normal to axis L, in other embodiments, the other can beat a different angle to axis L.

While various embodiments of the invention have been described above, itshould be understood that they have been presented by way of exampleonly and are not limiting on the invention. Thus, the breadth and scopeof the invention should not be limited by any of the above-describedembodiments, but should be defined only in accordance with the claimsand their equivalents.

What is claimed is:
 1. A steering mechanism for use as part of a medicaldevice, comprising: an elongate housing adapted to be coupled to asteerable member of a medical device; and an actuation system coupled tothe elongate housing, the actuation system adapted to control movementof the steerable member of the medical device within a body of apatient, the actuation system including an actuator, a first cam, and asecond cam, wherein: the actuator is adapted to move the first cam froma first position to a second position different than the first positionwhen the actuator is moved in a first direction about a first axis, thefirst cam is adapted to move the steerable member of the medical devicein a first direction along a first plane when the first cam is movedfrom the first position to the second position, the actuator is adaptedto move the second cam from a first position to a second positiondifferent than the first position when the actuator is moved in a firstdirection about a second axis different than the first axis, the secondcam is adapted to move the steerable member of the medical device in afirst direction along a second plane when the second cam is moved fromthe first position to the second position, and the first cam is adaptedto move about the first axis and the second axis, and the first cam andthe second cam are adapted to rotate about the first axis, wherein theelongate housing includes a first grip portion and a second grip portiondifferent than the first grip portion, and the actuator is coupled tothe elongate housing between the first grip portion and the second gripportion.
 2. The steering mechanism of claim 1, further comprising aprotrusion coupled to the first cam, the protrusion adapted to move in afirst direction when the actuator is moved in its first direction aboutthe second axis, the protrusion adapted to engage a portion of thesecond cam at least partially through a recess defined by the second camas the protrusion is moved in its first direction.
 3. The steeringmechanism of claim 2, wherein the protrusion is adapted to move thesecond cam from its first position to its second position as theprotrusion is moved in the first direction.
 4. The steering mechanism ofclaim 1, wherein the actuation system is adapted for one-fingeredoperation by a user.
 5. The steering mechanism of claim 1, wherein theelongate housing is adapted to be in a first orientation whenoperatively held by the first grip portion, and the elongate housingadapted to be in a second orientation different than the firstorientation when operatively held by the second grip portion.
 6. Thesteering mechanism of claim 1, wherein the elongate housing includes aproximal end portion and a distal end portion that each extend along anaxis, wherein the axis of the proximal end portion is offset from theaxis of the distal end portion.
 7. The steering mechanism of claim 1,wherein the actuator is adapted to move the first cam from its secondposition to at least one of the first position or a third positiondifferent than the first position when the actuator is moved in a seconddirection different than the first direction about the first axis, thefirst cam adapted to move the steerable member in a second directiondifferent than the first direction along the first plane when the firstcam is moved from the second position to the at least one of the firstposition or the third position.
 8. The steering mechanism of claim 1,wherein the actuator is adapted to move the second cam from the secondposition to at least one of the first position and a third positiondifferent than the second position when the actuator is moved in asecond direction different than the first direction about the secondaxis, the second cam adapted to move the steerable member in a seconddirection different than the first direction along the second plane whenthe second cam is moved from the second position to the at least one ofthe first position or the third position.
 9. The steering mechanism ofclaim 1, wherein the first cam is adapted to be moved from its firstposition to its second position independently of movement of the secondcam from its first position to its second position.
 10. The steeringmechanism of claim 1, wherein the second cam is adapted to be moved fromits first position to its second position independently of movement ofthe first cam from its first position to its second position.
 11. Thesteering mechanism of claim 1, further comprising: a Bowden cabledisposed over a portion of a wire coupled to the actuator, the Bowdencable adapted to move relative to the wire when the wire is moved inresponse to movement of the actuator.
 12. The steering mechanism ofclaim 1, wherein the actuator is movable in the first direction aboutthe first axis and in the first direction about the second axissubstantially simultaneously.
 13. A steering mechanism for use with oras part of a medical device, comprising: a housing adapted to be coupledto a medical device including a steerable portion; an actuator coupledto the housing, the actuator movable with respect to the housing in afirst direction about a first axis, the actuator movable with respect tothe housing in a first direction about a second axis different than thefirst axis; a first cam movable in response to movement of the actuatorin the first direction about the first axis and in the first directionabout the second axis, the first cam adapted to move the steerableportion of the medical device along a first plane; a second cam movablein response to movement of the actuator in the first direction about thesecond axis, the second cam adapted to move the steerable portion of themedical device along a second plane different than the first plane; anda protrusion coupled to the first cam, the protrusion adapted to move ina first direction when the actuator is moved in its first directionabout the second axis, the protrusion adapted to engage a portion of thesecond cam at least partially through a recess defined by the second camas the protrusion is moved in its first direction to cause rotation ofthe second cam about the first axis.
 14. The steering mechanism of claim13, wherein the actuator is adapted for one-fingered operation by auser.
 15. The steering mechanism of claim 13, wherein the protrusion isadapted to move the second cam from a first position to a secondposition different than the first position, the second cam adapted tomove the steerable portion of the medical device in a first directionalong the second plane as the second cam moves from its first positionto its second position.
 16. The steering mechanism of claim 13, furthercomprising: a wire coupled to the actuator, the wire adapted to move thesteerable portion of the medical device; and a Bowden cable disposedover at least a portion of the wire, the wire movable with respect tothe Bowden cable.
 17. A steering mechanism for use as part of a medicaldevice, comprising: an elongate stationary housing adapted to be coupledto a steerable member of a medical device; and an actuation systemcoupled to the elongate stationary housing, the actuation system adaptedto control movement of the steerable member of the medical device withina body of a patient, the actuation system including an actuator, a firstcam, and a second cam, wherein: the actuator is adapted to move thefirst cam about a first axis from a first position to a second position,the first cam is adapted to move the steerable member of the medicaldevice along a first plane when the first cam is moved from the firstposition to the second position, the actuator is adapted to move thefirst cam about a second axis substantially normal to the first axisfrom a third position to a fourth position, the second cam is adapted tomove the steerable member of the medical device along a second planewhen the first cam is moved from the third position to the fourthposition, and the first cam and the second cam are adapted to rotateabout the first axis.